Comparison of the predictive value of tip-apex distance and calcar referenced tip-apex distance in treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Yuwei , FENG Juntao , CHEN Yu , SHI Meng , YU Zhongxiang , FANG Lei , ZHOU Lin ,  XU Shengming

Department of Orthopaedics, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, P.R.China;

Corresponding author：

XU Shengming, Email: smmu2004@126.com

Keywords：

Femoral intertrochanteric fracture; Asian type proximal femoral nail; tip-apex distance; calcar-referenced tip-apex distance; internal fixation; complication

DOI：

10.7507/1002-1892.202004090

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Objective To compare the predictive value of the two concepts for complications by comparing the incidences of surgical complications associated with different tip-apex distance (TAD) and calcar referenced tip-apex distance (Cal-TAD) in the treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail (APFN) fixation. Methods A total of 188 cases of femoral intertrochanteric fractures treated with APFN fixation between January 2014 and December 2018 were collected according to inclusion criteria. TAD and Cal-TAD were measured on the X-ray film at immediate after operation; the patients were divided into two groups according to the measurement results: <25 mm and ≥25 mm. Gender, age, and fracture side and AO type were recorded. The patients in each group were reviewed whether there was delayed fracture union or nonunion, whether the screw blade moved axially, whether the femoral neck collapsed or even screw blade cut out, whether the internal fixator became loose or broken within 12 months after operation. Then statistical analysis was performed. Results There were 119 patients with TAD<25 mm and 69 patients with TAD≥25 mm, and 142 patients with Cal-TAD<25 mm and 46 patients with Cal-TAD≥25 mm. There was no significant difference in gender, age, or fracture side and AO type between groups (P>0.05). During the follow-up, 6 patients (5.04%) with TAD<25 mm, 10 patients (14.49%) with TAD≥25 mm had complications, and 1 patient (0.70%) with Cal-TAD<25 mm and 15 patients (32.61%) with Cal-TAD≥25 mm had complications. There were significant differences in the incidence of complication between the patients with different TAD, between the patients with different Cal-TAD, and between patients with TAD<25 mm and Cal-TAD<25 mm (P<0.05). Conclusion In the operation of femoral intertrochanteric fracture with APFN fixation, surgical complications can be significantly reduced when TAD or Cal-TAD was controlled within 25 mm, Cal-TAD is more significant in the prediction of postoperative complications.

Citation： CAI Yuwei, FENG Juntao, CHEN Yu, SHI Meng, YU Zhongxiang, FANG Lei, ZHOU Lin, XU Shengming. Comparison of the predictive value of tip-apex distance and calcar referenced tip-apex distance in treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(11): 1359-1363. doi: 10.7507/1002-1892.202004090 Copy

1.	Lamb JN, Panteli M, Pneumaticos SG, et al. Epidemiology of pertrochanteric fractures: our institutional experience. Eur J Trauma Emerg Surg, 2014, 40(3): 225-232.
2.	Efstathopoulos NE, Nikolaou VS, Lazarettos JT. Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. Int Orthop, 2007, 31(1): 71-76.
3.	Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res, 1980, (146): 53-61.
4.	Stern R, Lübbeke A, Suva D, et al. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. Int Orthop, 2011, 35(12): 1855-1861.
5.	Nishiura T, Nozawa M, Morio H. The new technique of precise insertion of lag screw in an operative treatment of trochanteric femoral fractures with a short intramedullary nail. Injury, 2009, 40(10): 1077-1083.
6.	Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
7.	Ruecker AH, Rupprecht M, Gruber M, et al. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma, 2009, 23(1): 22-30.
8.	De Bruijn K, den Hartog D, Tuinebreijer W, et al. Reliability of predictors for screw cutout in intertrochanteric hip fractures. J Bone Joint Surg (Am), 2012, 94(14): 1266-1272.
9.	Ibrahim I, Appleton PT, Wixted JJ, et al. Implant cut-out following cephalomedullary nailing of intertrochanteric femur fractures: are helical blades to blame? Injury, 2019, 50(4): 926-930.
10.	Goffin JM, Jenkins PJ, Ramaesh R, et al. What is the relevance of the tip-apex distance as a predictor of lag screw cut-out? PLoS One, 2013, 8(8): e71195.
11.	Kuzyk PR, Zdero R, Shah S, et al. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma, 2012, 26(7): 414-421.
12.	Born CT, Karich B, Bauer C, et al. Hip screw migration testing: first results for hip screws and helical blades utilizing a new oscillating test method. J Orthop Res, 2011, 29(5): 760-766.
13.	Liu W, Zhou D, Liu F, et al. Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg, 2013, 75(2): 304-310.
14.	Nikoloski AN, Osbrough AL, Yates PJ. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res, 2013, 8: 35.
15.	Rubio-Avila J, Madden K, Simunovic N, et al. Tip to apex distance in femoral intertrochanteric fractures: a systematic review. J Orthop Sci, 2013, 18(4): 592-598.
16.	Kane P, Vopat B, Heard W, et al. Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement. Clin Orthop Relat Res, 2014, 472(8): 2492-2498.
17.	高令军, 裘世静. 股骨距的三维结构和显微结构特征及其力学意义. 中华骨科杂志, 1999, 19(2): 109-112.
18.	Li S, Chang SM, Jin YM, et al. A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury, 2016, 47(6): 1302-1308.
19.	李双, 张立智, 张世民. 尖顶距与股距尖顶距的研究进展. 中华创伤骨科杂志, 2016, 18(8): 733-736.
20.	李海丰, 王华, 张英琪, 等. 头髓钉治疗高龄股骨转子间骨折的尖顶距与螺旋刀片移位的关系. 中国修复重建外科杂志, 2019, 33(10): 1234-1238.
21.	John B, Sharma A, Mahajan A, et al. Tip-apex distance and other predictors of outcome in cephalomedullary nailing of unstable trochanteric fractures. J Clin Orthop Trauma, 2019, 10(Suppl 1): S88-S94.

1. Lamb JN, Panteli M, Pneumaticos SG, et al. Epidemiology of pertrochanteric fractures: our institutional experience. Eur J Trauma Emerg Surg, 2014, 40(3): 225-232.
2. Efstathopoulos NE, Nikolaou VS, Lazarettos JT. Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. Int Orthop, 2007, 31(1): 71-76.
3. Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res, 1980, (146): 53-61.
4. Stern R, Lübbeke A, Suva D, et al. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures. Int Orthop, 2011, 35(12): 1855-1861.
5. Nishiura T, Nozawa M, Morio H. The new technique of precise insertion of lag screw in an operative treatment of trochanteric femoral fractures with a short intramedullary nail. Injury, 2009, 40(10): 1077-1083.
6. Baumgaertner MR, Curtin SL, Lindskog DM, et al. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg (Am), 1995, 77(7): 1058-1064.
7. Ruecker AH, Rupprecht M, Gruber M, et al. The treatment of intertrochanteric fractures: results using an intramedullary nail with integrated cephalocervical screws and linear compression. J Orthop Trauma, 2009, 23(1): 22-30.
8. De Bruijn K, den Hartog D, Tuinebreijer W, et al. Reliability of predictors for screw cutout in intertrochanteric hip fractures. J Bone Joint Surg (Am), 2012, 94(14): 1266-1272.
9. Ibrahim I, Appleton PT, Wixted JJ, et al. Implant cut-out following cephalomedullary nailing of intertrochanteric femur fractures: are helical blades to blame? Injury, 2019, 50(4): 926-930.
10. Goffin JM, Jenkins PJ, Ramaesh R, et al. What is the relevance of the tip-apex distance as a predictor of lag screw cut-out? PLoS One, 2013, 8(8): e71195.
11. Kuzyk PR, Zdero R, Shah S, et al. Femoral head lag screw position for cephalomedullary nails: a biomechanical analysis. J Orthop Trauma, 2012, 26(7): 414-421.
12. Born CT, Karich B, Bauer C, et al. Hip screw migration testing: first results for hip screws and helical blades utilizing a new oscillating test method. J Orthop Res, 2011, 29(5): 760-766.
13. Liu W, Zhou D, Liu F, et al. Mechanical complications of intertrochanteric hip fractures treated with trochanteric femoral nails. J Trauma Acute Care Surg, 2013, 75(2): 304-310.
14. Nikoloski AN, Osbrough AL, Yates PJ. Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study. J Orthop Surg Res, 2013, 8: 35.
15. Rubio-Avila J, Madden K, Simunovic N, et al. Tip to apex distance in femoral intertrochanteric fractures: a systematic review. J Orthop Sci, 2013, 18(4): 592-598.
16. Kane P, Vopat B, Heard W, et al. Is tip apex distance as important as we think? A biomechanical study examining optimal lag screw placement. Clin Orthop Relat Res, 2014, 472(8): 2492-2498.
17. 高令军, 裘世静. 股骨距的三维结构和显微结构特征及其力学意义. 中华骨科杂志, 1999, 19(2): 109-112.
18. Li S, Chang SM, Jin YM, et al. A mathematical simulation of the tip-apex distance and the calcar-referenced tip-apex distance for intertrochanteric fractures reduced with lag screws. Injury, 2016, 47(6): 1302-1308.
19. 李双, 张立智, 张世民. 尖顶距与股距尖顶距的研究进展. 中华创伤骨科杂志, 2016, 18(8): 733-736.
20. 李海丰, 王华, 张英琪, 等. 头髓钉治疗高龄股骨转子间骨折的尖顶距与螺旋刀片移位的关系. 中国修复重建外科杂志, 2019, 33(10): 1234-1238.
21. John B, Sharma A, Mahajan A, et al. Tip-apex distance and other predictors of outcome in cephalomedullary nailing of unstable trochanteric fractures. J Clin Orthop Trauma, 2019, 10(Suppl 1): S88-S94.

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Comparison of the predictive value of tip-apex distance and calcar referenced tip-apex distance in treatment of femoral intertrochanteric fractures with Asian type proximal femoral nail fixation

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